[1990 - 2004年法国武装部队甲型肝炎免疫接种的影响及预测] - Suppr

Richard V, Haus R, Verret C, Molinier S, Hugard L, Nicand E, Spiegel A, Buisson Y

Direction centrale du Service de Santé des Armées, section Epidémiologie, BP 145, 00459 Vincennes Armées.

Rev Epidemiol Sante Publique. 2006 Oct;54(5):433-41. doi: 10.1016/s0398-7620(06)76741-4.

BACKGROUND

Hepatitis A is a public health problem specially for migrants or travellers from industrialized countries with a low hepatitis A endemic level. French armed forces adopted an immunization strategy which first targeted overseas forces and subsequently was extended to all armed forces. In this work we studied the impact of this policy.

METHODS

Epidemiological surveillance data from 1990 to 2004 was analyzed by Poisson regression and exponential models of decrease used to forecast future rates.

RESULTS

From the 826 cases of hepatitis A reported during the study period, 266 (32.2%) occurred in overseas forces and 560 (67.8%) in forces stationed in France. Three periods could be identified in the decline of annual incidence: before 1994, with an average rate of 23.2 per 100,000; from 1994 to 1998: 10.2; and after 1998: 1.2 for all French armed forces. For overseas armed forces, the average rate was 117 per 100,000 before 1994 and 17.1 from 1994 to 1998 (p<0.001). For armed forces stationed in France, the average rate was 12.2 per 100,000 before 1998 and 0.9 after (p<0.001). For overseas armed forces, models clearly described the declining incidence subsequent to targeted immunization in 1995 and for armed forces stationed in France, the decline with generalized immunization starting in 1998.

DISCUSSION

The impact of immunization against hepatitis A virus was significant both in an overseas population and in a population staying in France where the risk level can be considered low due to the low endemic rate in France. These results suggest that immunization should be proposed not only for travellers but also for the general population based on real knowledge of the situation and cost-effectiveness analyses.

背景

甲型肝炎是一个公共卫生问题，对于来自甲型肝炎低流行水平工业化国家的移民或旅行者而言尤为如此。法国武装部队采取了一项免疫策略，该策略首先针对海外部队，随后扩展至所有武装部队。在本研究中，我们探讨了这一政策的影响。

方法

采用泊松回归分析1990年至2004年的流行病学监测数据，并使用指数下降模型预测未来发病率。

结果

在研究期间报告的826例甲型肝炎病例中，266例（32.2%）发生在海外部队，560例（67.8%）发生在驻扎在法国的部队。年发病率下降可分为三个阶段：1994年之前，平均发病率为每10万人23.2例；1994年至1998年：10.2例；1998年之后：所有法国武装部队为1.2例。对于海外武装部队，1994年之前平均发病率为每10万人117例，1994年至1998年为17.1例（p<0.001）。对于驻扎在法国的部队，1998年之前平均发病率为每10万人12.2例，之后为0.9例（p<0.001）。对于海外武装部队，模型清晰地描述了1995年针对性免疫接种后发病率的下降情况，对于驻扎在法国的部队，则描述了1998年开始全面免疫接种后的发病率下降情况。